Healthcare Provider Details

I. General information

NPI: 1669036901
Provider Name (Legal Business Name): LOLEITA LEANORA GREEN-REID APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 N WINDSONG DR STE 200
PRESCOTT VALLEY AZ
86314-2255
US

IV. Provider business mailing address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

V. Phone/Fax

Practice location:
  • Phone: 928-583-1000
  • Fax:
Mailing address:
  • Phone: 928-771-3122
  • Fax: 928-771-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: